Self‐sampling as the principal modality for population based cervical screening: Five‐year follow‐up of the <scp>PaVDaG</scp> study

Stanczuk, Grazyna; Currie, Heather; Forson, William; Baxter, Gwendoline; Lawrence, J. R.; Wilson, Allan; Palmer, Timothy J.; Arbyn, Marc; Cuschieri, Kate

doi:10.1002/ijc.33888

Cited by 14 publications

(10 citation statements)

References 31 publications

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“…Self-sampling is now widely accepted as being clinically non-inferior to conventional clinician-taken samples. (22,25,26) Although we found the sensitivity of NS sampling to CIN2+ to be slightly lower than for self-sampling, the confidence intervals overlapped, and no women in the routine screening population were speculum-positive/NS-negative. Given the two collection methods are technically the same, it would be surprising if clinical performance was inferior to self-sampling.…”

Section: Discussionmentioning

confidence: 62%

Non-speculum clinician-taken samples for human papillomavirus testing: a cross-sectional study in older women

et al. 2022

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Background: Cervical cancer incidence and mortality are high in women aged 65 and above, despite being preventable by screening. Speculum-based screening can become more uncomfortable after the menopause. Aims: To examine test performance and acceptability of HPV testing on clinician-collected vaginal samples without a speculum (non-speculum). Design and Setting: Cross-sectional study in 11 GP practices and 4 colposcopy clinics in London, UK, August 2017–January 2019. Methods: Non-speculum and conventional (speculum) samples were collected from women attending colposcopy aged ≥50 (following a speculum HPV-positive screening result) or aged ≥35 (with confirmed CIN2+) and women aged 50-64 attending routine screening. Sensitivity to CIN2+ was assessed among women with confirmed CIN2+ (colposcopy). Specificity to HPV relative to speculum sampling and overall concordance was assessed among cytology-negative women (routine screening). Results: The sensitivity of non-speculum sampling for detecting CIN2+ was 83.3% (95% CI: 58.6-96.4%) (N=15/18). There was complete concordance among CIN2+ women who had a speculum sample within 91 days prior to the non-speculum sample (N=12). Among 204 cytology-negative women, the specificity to HPV was 96.4% (95% CI: 92.7-98.5%), with 96.6% concordant results (Cohen’s kappa=72.4%). Most women (77.8%, 133/171) preferred the experience of non-speculum sampling over conventional screening, with two-thirds preferring a non-speculum sample for their next screen (65.9%, 120/170). Conclusion: HPV testing on non-speculum clinician-taken samples is a viable approach which warrants further exploration in larger studies. Non-speculum samples had excellent concordance with speculum (conventionally-taken) samples for detecting HPV, with overall test performance broadly comparable to that of self-sampling.

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Section: Discussionmentioning

confidence: 62%

Non-speculum clinician-taken samples for human papillomavirus testing: a cross-sectional study in older women

et al. 2022

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“…There are few reports on the prognostic impact of self-or urine-sampling HPV test results. Stanczuk et al [23] reported longitudinal data on the CIN progression rate with known HPV results 3-5 years after the HPV self-sampling test result. They revealed that the 5-year risk of CIN grade 2 is low in patients with high-risk HPV-negative females performing self-sampling using a polymerase chain reaction-based test [23].…”

Section: Discussionmentioning

confidence: 99%

Human papillomavirus self-sampling and urine-sampling tests and the management and short-term outcomes of cervical intraepithelial neoplasia: A prospective observational study

Matsuura

Tamate

Nagao

et al. 2023

Preprint

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Background: The importance of human papillomavirus (HPV) co-testing using physician-, self-, and urine-collected samples to predict cervical intraepithelial neoplasia (CIN) grade 1–2 prognoses has not been previously reported. Therefore, this study aimed to investigate the outcomes of patients with CIN 1–2 who simultaneously underwent physician-, self-, and urine-collection sampling tests. Methods: This study was conducted in Japan between October 2019 and November 2022 and examined the proportion of cases with CIN 1–2 progressions, the percentage of cases with persistent CIN 1–2, and the outcome differences according to the results of physician-, self-, and urine sampling tests. Results: There were 105 and 59 CIN 1 and 2 cases, with progression or persistence in 27 (29.3%) and 21 (50.0%) cases, respectively. The median follow-up was 20 and 12 months, respectively. Progression and persistence of CIN 1 were significantly associated with HPV-positive physician- and self-collection samples. No significant difference was observed between cases with CIN 2 who had HPV-positive and HPV-negative results using any sampling method. Conclusions: Physician- and self-testing for HPV are crucial for predicting disease progression risk in CIN 1 cases. Future research with an extended observation period and consideration of the progression risks is warranted.

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“…One change idea that we were not able to introduce during our project was self-sampling for those who decline conventional cervical screening, as studies have shown this is acceptable to women,40 and is safe to use within a screening programme 41. A clinical trial of self-sampling commenced in England in 2021 for patients within the NHS CSP 42.…”

Section: Discussionmentioning

confidence: 99%

Improving the uptake of cervical screening in pregnant and recently postnatal women: a quality improvement project

et al. 2022

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BackgroundIn 2018, cervical screening uptake was at its lowest level since screening began, particularly in those aged 25–35, coinciding with the peak incidence of cervical cancer and average age at first delivery.ProblemRetrospective baseline data of pregnant women found 47.3% (n=123/260) were overdue for screening by delivery, of whom 74% (n=91/123) remained overdue by 6 months postnatal.MethodsWe undertook a quality improvement project from April 2018 to April 2019 to improve cervical screening uptake in pregnant and postnatal women. We mapped out the screening process and canvassed stakeholders. The main theme was inconsistency of advice received by women. From February 2018 to May 2020, we undertook a prospective audit of 10 women per week who gave birth in our maternity department, recording screening status at delivery and 6 months postnatal.Interventions included introducing evidence-based guidelines about cervical screening in pregnancy and the postnatal period, flow charts for maternity staff, multiprofessional teaching for all maternity staff and information dissemination to women (via the HANDiApp platform, a social media campaign and adapting results letters following colposcopy, highlighting dates when screening would be due). Primary care opening hours were extended for screening and women received a letter from their midwives, if they required cervical screening in pregnancy.ResultsLocally, the percentage of women overdue for cervical screening by 6 months postnatal improved by 8.0% during this project, compared with a 1.6% change in national screening rates in women aged 25–49.ConclusionsWe increased the percentage of local pregnant and postnatal women attending cervical screening by introduction of a package of information, targeted education and widening access to screening appointments.

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Self‐sampling as the principal modality for population based cervical screening: Five‐year follow‐up of the PaVDaG study

Cited by 14 publications

References 31 publications

Non-speculum clinician-taken samples for human papillomavirus testing: a cross-sectional study in older women

Non-speculum clinician-taken samples for human papillomavirus testing: a cross-sectional study in older women

Human papillomavirus self-sampling and urine-sampling tests and the management and short-term outcomes of cervical intraepithelial neoplasia: A prospective observational study

Improving the uptake of cervical screening in pregnant and recently postnatal women: a quality improvement project

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